A case study of five dialysis patients who developed various types of cytopenia due to copper deficiency

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  • 銅欠乏症による種々の血球減少症を併発した透析患者の5例
  • 症例報告 銅欠乏症による種々の血球減少症を併発した透析患者の5例
  • ショウレイ ホウコク ドウ ケツボウショウ ニ ヨル シュジュ ノ ケッキュウ ゲンショウショウ オ ヘイハツ シタ トウセキ カンジャ ノ 5レイ

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Abstract

<p>We report the cases of 5 patients (1 male, 4 females; mean age: 76 years old), who developed various types of cytopenia due to copper deficiency. The mean duration of the dialysis period was 5.2 years. The patients’ concomitant diseases included aspiration pneumonia (n=3), cranial nerve disorders (n=2), dialysis access infections (n=2), malnutrition after colon cancer surgery (n=1), and pyogenic spondylitis (n=1). Enteral alimentation was employed in 1 patient, and zinc preparations were administered to 4 patients. The mean concentrations of blood copper and ceruloplasmin at the time of diagnosis were 26.6 μg/dL (7 to 46) and 12.6 mg/dL (6 to 17), respectively. As for the patients’ cytopenic patterns, 2 patients had pancytopenia, 2 patients had anemia and platelet depletion, and one patient had anemia alone. Three patients received oral copper sulfate, one patient took pure cocoa, and one patient received copper supplements. The patients’ blood cell counts improved as their copper concentrations increased in all cases. As they are subjected to phosphorus restriction, dialysis patients often have to eat foods that contain large amounts of copper. Furthermore, the absorption of copper in the intestinal tract might be inhibited by zinc supplementation. Therefore, it is suggested that dialysis patients are more prone to copper deficiency than healthy individuals. Furthermore, copper deficiency is associated with erythropoietin-stimulating agent-resistant anemia combined with leukopenia or thrombocytopenia in hemodialysis patients.</p>

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